March 25, 2013
In the United States, Los Angeles County has the largest incident population of HIV-positive individuals and now ScienceDaily reports that a new study from the University of Southern California (USC) Schaeffer Center for Health Policy and Economics and the RAND Corporation has found that "One of the most widely advocated strategies for dealing with HIV/AIDS could double the number of multi-drug-resistant HIV cases in the population of men who have sex with men (MSM) in LA County over the next 10 years." Advance online publication of the study is available in Clinical Infectious Diseases.
The so-called "test and treat" policy -- which calls for universal testing for HIV, as well as treatment with antiretroviral drugs for everyone who is found to be HIV-positive, even in the early stages of the disease -- has been shown to decrease the number of new HIV cases and deaths due to AIDS. The problem, according to the study, is that "such aggressive and widespread use of antiretroviral drugs would also rapidly and dramatically increase the prevalence of multiple-drug-resistant HIV (MDR)."
"We're not saying that testing everybody and treating everybody is bad. All we're saying is that you should proceed with caution and closely monitor the prevalence of multi-drug-resistant HIV as you scale up the test and treat model," said lead author Neeraj Sood, associate professor at the USC Schaeffer Center.
Sood and his colleagues studied the MSM population in L.A. County, which accounts for 82 percent of people living with HIV/AIDS countywide. They tracked how the disease was treated from 2000 to 2009 and how the virus responded. Using data from the Centers for Disease Control and their own data, the researchers then generated a model of how the disease would respond under a more aggressive "test and treat" policy over the next 10 years. The model showed the prevalence of MDR HIV jumping from 4.79% to 9.06% by 2023.A more cautious approach, according to Sood, would be simply to aggressively test for the disease but avoid prescribing antiretroviral drugs to asymptomatic patients, in opposition to the current practice of many providers to start treatment early. (see "Timing and T-Cells" by HIV specialist Dr. Howard Grossman in Positively Aware's 17th Annual HIV Drug Guide).